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Updated: Jul 19, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Meta-Analysis of the Outcomes of Peri-Device Leak After Left Atrial Appendage Closure
Mostafa Reda Mostafa1, Mohamed Magdi Eid1, Mohamed Abuelazm2
1Department of Medicine, Rochester Regional Health, Unity Hospital, Rochester, New York.
Insights
Peri-device leak (PDL) after left atrial appendage closure (LAAC) increases the risk of stroke, transient ischemic attack, or systemic embolism. This finding highlights the importance of monitoring PDL post-LAAC to mitigate thromboembolic events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage closure (LAAC) is a strategy to prevent stroke in patients with atrial fibrillation.
- Peri-device leak (PDL) is a potential complication following LAAC procedures.
- The clinical significance of PDL on long-term outcomes remains an area of active investigation.
Purpose of the Study:
- To systematically review and meta-analyze the available evidence on the impact of PDL after LAAC.
- To evaluate the association between PDL and the risk of thromboembolic events and mortality.
Main Methods:
- A comprehensive search of PubMed/Medline, Embase, and Google Scholar was performed for studies reporting PDL outcomes post-LAAC up to October 2022.
- The primary outcome was a composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE).
- Random-effects models were used for outcome pooling, with I² statistics assessing heterogeneity.
Main Results:
- The meta-analysis included 54,279 patients from 11 studies.
- PDL was significantly associated with an increased risk of the composite outcome (stroke, TIA, or SE) (OR 1.63, 95% CI 1.06-2.52, P=0.03).
- No significant differences were observed in all-cause mortality, cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus.
Conclusions:
- PDL following LAAC is linked to a higher risk of thromboembolic events.
- The presence of PDL does not appear to significantly affect patient mortality.
- Further research may be warranted to optimize LAAC techniques and management strategies to minimize PDL.
Abstract:
Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE). Secondary outcomes included all-cause and cardiovascular mortality, ischemic stroke, TIA, and device-related thrombus. Outcomes were pooled using random-effects models. We used I2 statistics to assess statistical heterogeneity; I2 >50% considered significant heterogeneity. This study included 54,279 patients from 11 studies (6 observational, 2 nonrandomized controlled trials [non-RCTs] primary results, 2 RCT post hoc analyses, and 1 analysis combining 2 RCTs data). PDL was associated with a significant increase in the composite outcome of stroke, TIA, or SE (odds ratio 1.63, 95% confidence interval 1.06 to 2.52, p = 0.03, I2 = 43%) as compared with cases with no PDL. There were no significant differences in all-cause or cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus. In conclusion, PDL after LAAC is associated with an increased risk of thromboembolism (composite stroke, TIA, or SE) without impacting mortality.
